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Faciale na twarzy Laili
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ECCA Grading Scale: An Original Validated Acne Scar Grading Scale for Clinical Practice in Dermatology
February 2007 Dermatology 214(1):46-51
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The ECCA grading scale (échelle d'évaluation clinique des cicatrices d'acné) is a tool designed to help dermatologists to assess the severity of acne scars and to standardize the discussions about the treatments of scars.
We developed an acne scar clinical grading scale called ECCA, which consists of 6 items designed to assess easily and quickly the severity of acne scars by a global score. The interobserver reliability of the ECCA grading was statistically validated.
The statistical analysis showed the interinvestigator reliability of the ECCA grading scale among 7 dermatologists who used it on the same group of 10 acne patients.
ECCA is a new tool which will now be available for dermatologists to use in their everyday practice and for clinical trials evaluating the efficacy of treatments on acne scars.
... Goodman and Baron proposed a quantitative and qualitative scar grading system based on the type and number of scars [13]. [14] . Pathological scarring may cause subjective symptoms such as pain and burning and itching sensations. ...
... Dreno i wsp. opracowali zwalidowany system ECCA (Echelle d'Evaluation clinique des Cicatrices d'acné), w którym odpowiednim rodzajom, wymiarom i liczbie blizn zlokalizowanych na twarzy odpowiadają wartości liczbowe [14] . ...
Scars are formed when a defect in the dermis is replaced with fibrous connective tissue. Sometimes scars limit the range of motion as a result of contractures. In addition, they are a source of severe subjective complaints and a significant cosmetic defect. People with visible scarring have been shown to have a reduced quality of life due to a sense of shame, anxiety, and the lack of public acceptance. The therapy of scars can be challenging, and may be associated with a risk of recurrence. Fractional laser treatments are currently a widely used therapeutic approach for scar management, both in paediatric and adult patients. The observed improvement in skin colour, decrease in tissue tension, and reduction of itching and pain experienced by the patient, combined with a low risk of adverse effects, determine the efficacy and safety of this treatment modality, and contribute to the satisfaction of patients with the final cosmetic result, thus improving their mental and emotional well-being.
... It may occur regardless of the severity of acne, especially when an effective treatment is delayed. [1, 2] As most of the acne scars appear on the face, it is a major cosmetic concern for a patient and presents a challenge to a dermatologist due to lack of effective treatment modalities. [3,4] Although many treatment modalities are currently being used, they have shown improvement to a limited extent with possible side effects. ...
... Clinical and dermatological examination was performed and grading of the acne scars was done according to the Goodman and Baron's qualitative global acne scarring grading system [ Table 1]. [2, 5] Patients were explained in detail about the procedure, time required, possible side effects, and prognosis of the treatment. Procedure was done free of cost for all the patients excluding the charges for medications and investigations. ...
Background: Platelet-rich plasma (PRP) is an autologous preparation which contains a large amount of platelets concentrated into a small volume of plasma. PRP provides various growth factors which aid in quick wound healing. It is used as an adjuvant therapy for acne scars. Thus, in this prospective study, the efficacy of PRP as single modality of treatment for acne scars was evaluated. Methods: Thirty patients of Grade 2 and 3 acne scars according to the Goodman and Baron's qualitative acne scar grading system and Fitzpatrick Skin Type IV and V received six sittings of PRP at an interval of 1 month and followed up for 3 months after the completion of six sittings. Patients were assessed for the improvement in the scar grade, 1 month after the last sitting. Pre- and post-treatment comparative photographs and patient's and physician's satisfaction score were used to assess the results. Results: All the types of scars showed response in terms of reduction in size. Rolling scars responded better to PRP as compared to boxcar and ice pick scars. Estimation of improvement with Goodman and Baron's global qualitative acne scarring system showed that out of 30 patients with Grade 2 and 3 acne scars, 50% showed improvement in terms of acne scar grading at the end of the treatment. Among 25 patients with Grade 3 scars, 15 patients (60%) showed improvement by one grade. Adverse effects were mild being limited to transient pain, erythema, edema, and hyperpigmentation. Conclusion: The current study introduces autologous PRP as a cost-effective, well-tolerated office procedure in the treatment of acne scars without serious side effects. Further studies are needed to be carried out to compare the results of this present study.
... 9,14,15,19,[25][26][27] Two studies that did not specify assessment methods mentioned overall improvements in both depth and appearance of acne scars. 10,20 One study using the Échelle d Évaluation Clinique des Cicatrices d'Acne (ECCA) grading scale 28 reported an average 6.9-point improvement (on a severity scale of 0-10). 16 An important limitation is that different studies used varying concentrations of TCA, and the specific concentration should be kept in mind when comparing the outcomes of these individual studies. ...
Background
Chemical reconstruction of skin scars (CROSS) applies a high strength acid focally to treat atrophic scars. Although this method has gained popularity over the past two decades, no standardized treatment guideline exists for CROSS method in the treatment of atrophic scars.

Aims
The purpose of this comprehensive review is to evaluate the indications, detailed techniques, efficacy and safety of CROSS method.

Materials and Methods
An extensive literature review was conducted to identify articles relating to CROSS method for atrophic scars from 2002 to 2018.

Results
The literature search yielded 19 articles meeting criteria. CROSS method has been used for the treatment of acne scars, varicella scars, enlarged pores and depressed surgical scars. In studies using the quantile grading scale for acne scars, 60‐100% of patients showed >25% improvement. In two studies for varicella scars, 83‐100% of patients showed >25% improvement. CROSS method seems to be effective specifically for ice‐pick scars. It is well tolerated and safe in Fitzpatrick skin phototypes I‐V. Most reported complications are temporary and include post‐inflammatory dyspigmentation, erythema, pain, pruritus, infection and widening of scars.

Conclusion
This literature review suggests that CROSS method is a safe and effective treatment for atrophic scars, especially ice‐pick scars, in skin types I‐V. However, current published works have several limitations, including small sample sizes, lack of control group, different concentrations of acid, different frequency of treatments and follow‐up periods. Larger, randomized, controlled studies are needed to elucidate the optimal treatment protocol of CROSS method.
... Acne scar formation results either due to increased tissue formation or damage of local tissue [1]. The severity of scarring depends upon the degree of tissue damage, inflammatory reaction and time lapsed from the onset of tissue inflammation [2, 3] . It can be classified into three different types: atrophic, hypertrophic, or keloidal. ...
... Qualitative assessment was conducted using Goodman and Barron qualitative system which has four grades: macular, mild, moderate, and severe [17]. If the severity was reduced by two grades and if the change in the grade of acne scarring was reduced by two grades, the improvement was considered excellent; if the reduction was by one grade, it was considered as good; and if there was no reduction, the improvement was considered poor [18] . ...
... Acne scarring ECCA (échelle d'évaluation clinique des cicatrices d'acné) grading scale [12] was used for acne scarring assessment. The global scores of V-shaped, U-shaped, M-shaped atrophic scars, superficial elastolysis, and hypertrophic scars were measured according to their respective weighting factors (Supplementary Table 1). ...
Acne scarring is one of the most common facial skin disorders. The appropriate treatments for acne scars in patients with rosacea have not been studied. This study was designed to evaluate the efficacy and safety of non-ablative fractional 1440-nm laser (1440-nm NAFL) therapy for treatment of atrophic acne scars in patients with rosacea. In this prospective, interventional study, 32 patients with rosacea and acne scars underwent three sessions of 1440-nm NAFL therapy. Therapy efficacy, epidermal barrier function, and side effects were evaluated. Thirty patients completed and the median acne scar scores significantly reduced from 45 (30, 50) to 15 (15, 30) after three treatments (P < 0.001). The improvement score of acne scars was 2.7 ± 0.7; 22 (73.3%) were satisfied or highly satisfied. The rosacea erythema scores changed from 2.1 ± 0.4 to 1.9 ± 0.5 (P = 0.326), and flushing, burning, and stinging were not worse. The oil content after treatments was significantly reduced (P < 0.001), while there was no significant difference in other indicators of skin barrier function. The quality-of-life score decreased from 17.5 ± 3.8 to 14.1 ± 3.0 (P < 0.001). No serious side effects were observed. The 1440-nm NAFL therapy is effective in the treatment of acne scaring in patients with rosacea with little damage to the skin barrier.
... The post effects of acne can also be evaluated with specially created instruments such as the postacne hyperpigmentation index (PAHPI) for measurement of postinflammatory hyperpigmentation, ECCA grading scale, Scale for Acne Scar Severity (SCAR-S), and Self-assessment of clinical acne-related scars (SCARS) for assessment of acne scarring [41] [42] [43][44][45]. ...
Many people suffer from impure, acne-like skin. This type of skin looks greasy and glossy, rough with enlarged pores, and has tendency to develop comedones, pimples, and pustules. It feels unpleasant and may be a serious cosmetic problem. The effective control over the impure skin requires daily application of multifunctional cosmetic products for cleansing and intensive care of the skin. Market products should have a proven effect. Testing on human volunteers using sensorial self- and expert evaluation, instrumental skin bioengineering techniques, and questionnaires for quality-of-life assessment are the preferred way to proof product claims.
... Improvement in acne scarring was graded using the ECCA grading scale (Table 1). 3 Based on the photographs, PIE was rated by the Clinician Erythema Assessment Scale (CEAS; Table 2). 4 Secondary outcome measures included, patient satisfaction with the treatment and self-reported pain. ...
The 755 nm picosecond Alexandrite laser has been demonstrated to be effective and well tolerated in patients with acne scars. In this split‐face, investigator‐blinded study, 16 patients with post‐inflammatory erythema (PIE) and acne scars were randomized to receive laser treatment on half the face, with the other half serving as a control. The treatment side demonstrated a significant improvement in both PIE and scars compared to the baseline and also when compared to the control side. Treatment was well‐tolerated, with only transient and mild erythema and edema reported as side‐effects. In our study the picosecond Alexandrite laser was safe and effective in the treatment of PIE and acne scars. Comprehensive treatment outcomes should be taken into consideration when deciding on which device to use.
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... Efficacy was assessed using digital photography taken at baseline and at 3 months. Two dermatologists who did not participate in the treatment scored the degree of scarring on both sides of the patient's face using the Echelle d'evaluation clinique des cicatrices d'acne (ECCA) grading scale, 8 as follows: A-values, V-shaped scars, punctuated atrophic scars, with a diameter of <2 mm, and a score of 15 (A1); Ushaped scars, with a diameter of 2-4 mm and sharp edges, and a score of 20 (A2); M-shaped scar, diameter >4 mm, with irregular edges, and a score of 25 (A3). B-values, quantitative scores for scar density, 0 score for no scar, 1 for ≤5 scars (B1); >5 and ≤20 scars counted as 2 points (B2); >20 scars counted as 3 points (B3). ...
Background:
Multiple approaches are used to treat acne scars, but some are expensive, ineffective, and cause complications. We aimed to evaluate the efficacy and safety of ultra-pulsed CO2 fractional laser combined with 30% supramolecular salicylic acid in the treatment of acne scars in a prospective split-face control study.

Methods:
Twenty patients with facial symmetrical acne scars were enrolled. One side of face was randomly treated with 30% supramolecular salicylic acid, and two sides were treated with ultra-pulsed CO2 fractional laser. The Echelle d'evaluation clinique des cicatrices d'acne (ECCA) scale was used to evaluate the clinical efficacy before and three months after treatment, and a quartile scale was used to self-evaluate the improvement of patients. A visual analog scale was used to record pain scores after each treatment, and side effects and other adverse reactions on the face were recorded.

Results:
All the patients completed treatment and follow-up. There was statistical difference in ECCA scores of bilateral facial acne scars after three treatments (P<0.001). ECCA scores on the combined side were lower after three treatments than those on the laser side (P=0.003). The patient satisfaction quartile scale on the combined side was higher than that on the laser side alone (P=0.015).

Conclusion:
Ultra-pulsed CO2 fractional laser combined with 30% supramolecular salicylic acid has better efficacy in the treatment of acne scars than laser alone, and patient self-assessment of combined treatment has a greater degree of improvement in acne scars, and does not increase patient pain scores and related adverse reactions. This article is protected by copyright. All rights reserved.
... Longer wavelength infrared lasers such as 1319-nm can penetrate deep into skin and can hence target sebaceous glands (18)(19) (20) . Neodymium-doped Yttrium Aluminum Garnet (Nd: Yag) 1320-nm laser has been reported as efficacious in trials (21,22). Water serves as its chromophore, generating thermal energy leading to dermal collagen remodeling. ...
Acne is one of the commonest problems of adolescence with almost half of the patients experiencing persistence into adulthood. Pulsed dye lasers (PDL) with wavelengths of 585 and 595 nm targeting hemoglobin have been used for the treatment of this condition and its sequelae. Recent introduction of PDL with a higher wavelength of 1319 nm has been reported to offer some benefit to acne patients. We reviewed the literature on the use of 595-nm and 1319-nm PDL in the management of acne. A PubMed literature search for search terms “pulsed dye laser,” “acne laser therapy,” “light therapy for acne,” “595 nm and acne,” “1319 nm and acne” was done. Studies, series and case reports were included. These lasers were compared to other lasers and light sources such as 532-nm Potassium Titanyl Phosphate laser, 585-nm PDLs, 1450-nm diode laser, 1540-nm erbium glass laser, intense-pulsed light (IPL), photodynamic therapy, red and blue light and short-pulsed 1064 nm laser utilized in acne management regarding their efficacy. Improvement in acne grading, scale severity or reduction in lesion count indicated substantial efficacy of the laser system utilized.
... The two basic scar types -depending on whether there is a net loss or gain of collagen -are atrophic (majority of scars) and hypertrophic scars and keloids (minority) [5]. Several classifications and scales of scarring have been proposed: Goodman and Baron [6,7] proposed a qualitative scale and then presented a quantitative scale, while Dreno et al. [8] introduced the ECCA scale (Echelle d'Evaluation Clinique des Cicatrices d'Acné). ...
Background:
Acne vulgaris is classified based on the severity of skin lesions and post-healing scar types of these lesions. Numerous epidemiology studies have investigated the risk factors associated with acne presentation and severity, but studies for acne scarring are lacking.

Objective:
To investigate the prevalence of acne, severity, and scarring grades and their associated risk factors among Singapore Chinese.

Methods:
A total of 3,888 subjects (2,090 cases/1,798 controls; median age = 21 ± 4.589; range 17-71) completed an investigator-administered questionnaire as part of a cross-sectional study, which included sociodemographics, familial medical history, lifestyle factors, dietary habits, and acne history. Acne cases were further evaluated for their severity (n = 991) and scarring (n = 988) grades by a trained personnel.

Results:
The majority of the acne cases had mild acne/grade 1 scarring, while less than 1% had severe acne/grade 4 scarring. Parental acne was significantly associated with acne presentation and moderate/severe acne, while sibling acne was significantly associated with grade 3/4 scarring. Gender and age affected acne severity and scarring but not acne presentation, while tertiary maternal education level and the possession of ≥3 siblings were particularly associated with acne scarring. Underweight BMI was protective against acne presentation, while atopic diseases (asthma, allergic rhinitis, eczema) were its predisposing factors. Of the evaluated lifestyle factors, computer/TV usage had significant association with acne presentation, while alcohol consumption was significantly associated with acne severity. Frequent milk consumption was associated with a protective effect for moderate-severe acne, while frequent butter consumption had a detrimental effect on acne scarring extent.

Conclusion:
Positive familial history is a strong predisposing factor in determining acne presentation, severity, and scarring. Demographic factors (gender, age) and sedentary lifestyle (increased computer/TV usage) influence acne presentation, while dietary habits (milk and butter consumption) influence acne severity and scarring. The predisposing factors revealed in this study could help us to gain insights into acne pathophysiology and hence develop interventions especially targeting modifiable risk factors.
... Although several scales are available to assess acne scarring, these typically do not have the ability to simultaneously consider other acne lesion types (eg, comedones, papules, pustules, and nodules). [13] [14] [15][16] In addition, these acne global grading systems often do not incorporate measurements for postinflammatory changes or erythema, which can often have significant relevance to patients with respect to their perceived severity of disease. Given the limitations of current grading systems, we sought to develop and validate a novel acne
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